Refund Application
Victor Valley College, Bursar’s Office, 18422 Bear Valley Road, Victorville, 92395-5850
PLEASE PRINT
Student ID #:
_________________________________________
Student Name:
_________________________________________
Mailing Address:
_________________________________________
City, State, Zip:
_________________________________________
Phone Number:
_________________________________________

*Parking will be refunded for all canceled classes. Parking Permit must be attached or returned to Campus Police
in order to receive a refund.

**Fees for Parking and ASB will be refunded if classes were dropped PRIOR to the first day of each semester.
ASB Card and Parking Permit must be attached in order to receive a refund.

Allow up to 6 weeks for processing.
Dropped Units
46 =
_____ x _____
0
$______
Student Transportation
$______
Canceled Units
46 =
_____ x _____
0
$______
Parking Permit*
$______
Out-of-State Tuition
259 =
_____ x _____
0
$______
Student Center
$______
Refund Processing Fee
-10
$______
______________________
$______
ASB Card**
$______
______________________
$______
Student Representation
$______
______________________
$______
Refund Due
___________________________________
________________________________
Student Signature
Date
FOR OFFICE USE ONLY:
Description
Enrollment
Tuition
Enrollment (Prior Year)
Tuition (Prior Year)
FACTS Overpayment
Miscellaneous Overpayment
Student Center Fee
Parking
ASB
Student Rep Fee
Student Transportation Fee
FT Materials
AJ Materials
Community Education
Community Ed – Phlebotomy
Contract Ed - CED01
Account Number
01-00-20-0000-0000-8874
01-00-20-0000-0000-8880
01-00-20-0000-0000-8899
01-00-20-0000-0000-8899
01-00-20-0000-0000-8899
01-00-20-0000-0000-8899
01-00-20-0000-0000-8883
01-50-20-0000-5001-8881
01-50-20-0000-4005-8849
01-50-20-0000-4005-8884
01-50-20-0000-4007-8886
01-50-20-0000-4060-8899
01-50-20-0000-4061-8899
01-50-20-0000-5003-8899
01-50-20-0000-5004-8872
01-50-20-0000-5018-8899
Refund Amount
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
-10
$______
Refund Term